PrepU Chapter 49
The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client? Potassium supplement Sodium restriction Iron supplement Renal dialysis
Iron supplement Iron supplementation is used adjunctively with epoetin to increase RBCs. The nurse would not expect a potassium supplement, sodium restriction or renal dialysis to be ordered.
A client, diagnosed with chronic renal failure, has begun experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with which resulting condition? thrombocytopenia hypoglycemia anemia hypertension
anemia A common condition associated with chronic renal failure is anemia. Shortness of breath in a client with chronic renal failure (without obvious fluid balance issues) is likely due to anemia and its effect on the body's ability to transport oxygen. None of the other options would cause the client's symptoms.
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant? "This medication will keep unnecessary clots from forming in my blood." "If a big clot starts to form, this medication will help break it up." "Anticoagulants thin the blood so clots can't get as big." "If I have another stroke, this medication will bust up the clot before too much damage is done."
"This medication will keep unnecessary clots from forming in my blood."
The component of the red blood cell that is not recycled is bilirubin. True False
True The only part of the RBC that cannot be recycled is the toxic pigment bilirubin, which is conjugated in the liver, passed into the bile, and excreted from the body in the feces or the urine.
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? Alteration in bowel elimination due to side effects of the medication Impaired tissue oxygenation related to anemia Altered skin integrity due to the disease process Alteration in nutrition due to poor intake of iron
Impaired tissue oxygenation related to anemia The most appropriate priority nursing diagnosis is impaired tissue oxygenation related to anemia. The other diagnoses are not specific to the reason that epoetin is prescribed or the specific side effects of the medication.
Colony-stimulating factors (CSF) are administered to produce which therapeutic effect? Decrease the patient's reaction to a chemotherapeutic medication Increase the growth of specific types of blood cells Reduce side effects to a medication Enhance immune system functioning
Increase the growth of specific types of blood cells Colony-stimulating factors control the production, growth, and differentiation of specific blood cell types, such as red blood cells and leukocyte stem cells. CSFs do not decrease the side effects to a medication or the patient's reaction to chemotherapeutic medications. Immune system functioning is not measurable and not the direct result of administration of a CSF. A CSF could enhance the production of RBCs or leukocyte stem cells. Colonies of granulocytes are stimulated by CSFs.
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? Increased WBC count Decreased RBC count Decreased WBC count Increased RBC count
Increased RBC count Epoetin is a hormone that stimulates bone marrow production of red blood cells.
A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen?
Iron Epoetin is not effective unless sufficient iron is present, and most clients need an iron supplement. When an iron preparation is prescribed, the home care nurse may need to emphasize the importance of taking it.
A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to: schedule an appointment to check if the patient has a high WBC count. schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks. stop taking the drug after a 2-week period. begin taking a calcium channel blocker to treat hypertension, which usually develops as an adverse effect of epoetin alfa therapy.
schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks. After each dose adjustment, the nurse should ensure that the patient makes an appointment to have the hemoglobin measured twice a week for at least 2 to 6 weeks to verify that it is in the normal range. A high WBC count and hypertension have not been identified as adverse effects of epoetin alfa.
A nurse administers erythropoietin. What assessment finding is attributable to the increased effect of this hormone? Select all that apply.
Increased red blood cell count Increased hemoglobin Erythropoietin stimulates the bone marrow and increases the production of red blood cells and hemoglobin. It does not increase urinary output or decrease oxygenation. It would actually increase the oxygen-carrying capacity of the blood. Anemia is a condition that erythropoietin might be used to treat, but it is not an assessment finding caused by this hormone.
A nurse has been assigned to a 43-year-old man who is to receive epoetin alfa therapy. The patient is HIV-positive and has anemia related to zidovudine therapy. The nurse will monitor: Chemotherapy Iron levels Swelling of veins Renal failure
Iron levels Monitoring iron and hematocrit levels may help the nurse track the progress and effectiveness of the epoetin alfa therapy. Chemotherapy is a cancer treatment, not an assessment that determines the success or effectiveness of the epoetin alfa therapy. Swelling of veins and renal failure are not normally monitored in an ongoing assessment of a patient who takes epoetin alfa.
When describing the function of vitamin B12, what would be appropriate to include? Oxygen transport to the tissues Maintenance of myelin sheath Prevention of neural tube defects Important role in cell division
Maintenance of myelin sheath Vitamin B12 is important for maintaining the myelin sheath. Folic acid is important in preventing neural tube defects and is essential for cell division in all types of tissues. RBCs are important for transporting oxygen to the tissues.
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? Heart failure Lung failure Renal failure Liver failure
Renal failure Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production of red blood cells (RBCs) in the bone marrow. It is often used in the treatment of anemia related to renal failure.
The nurse is caring for a patient with chronic kidney disease who is receiving epoetin alfa. Which assessment finding would be of greatest concern for the nurse? Dry, nonproductive cough 1 pound weight gain in 1 week A rash under the breast Reports of calf pain on dorsiflexion of the foot
Reports of calf pain on dorsiflexion of the foot The nurse should determine whether the patient has pre-existing vascular disease, because it may increase the patient's risk for developing thrombotic adverse effects.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Beta cells Stem cells Alfa cells Theta cells
Stem cells All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.
A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request? The oral route while more desirable is not as effective. This drug is destroyed by acids found in the stomach. This medication is likely to causes severe diarrhea if given orally. The drug dose must be increased if being given via the oral route.
This drug is destroyed by acids found in the stomach. Epoetin alfa is given by subcutaneous or intravenous (IV) injection because it would be destroyed by digestive enzymes if given orally. None of the other options accurately describe why the oral route is not an option.
The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication?
Uncontrolled hypertension The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.
A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS?
Vitamin B12 Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.
A client who is undergoing chemotherapy for the treatment of non-Hodgkin's lymphoma will soon begin treatment with epoetin alfa. The nurse should be aware that this drug may be administered by which route? Select all that apply. buccal oral subcutaneous intravenous intramuscular
subcutaneous intravenous Epogen is administered by either IV or sub-Q routes. None of the other routes allow for the effective absorption of the medication.
The nurse is teaching a client about folinic acid rescue in chemotherapy. Which of the following information would the nurse include in the teaching plan? Folinic acid rescue in chemotherapy includes levothyroxine administration. Folinic acid rescue in chemotherapy includes leucovorin administration. Folinic acid rescue in chemotherapy includes Levophed administration. Folinic acid rescue in chemotherapy includes Lipitor administration.
Folinic acid rescue in chemotherapy includes leucovorin administration. Folinic acid rescue in chemotherapy includes leucovorin administration. Levophed, Lipitor, and levothyroxine are not part of the acid rescue because the goal is to save cells.
Adverse effects of epoetin and darbepoetin include increased risks of what condition? Diabetes mellitus type 2 Cirrhosis of the liver Myocardial infarction Hyperlipidemia
Myocardial infarction Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.
A client is to receive clopidogrel. The nurse would expect to administer this agent by which route? Subcutaneous Intramuscular Oral Intravenous
Oral Clopidogrel is administered orally.
After teaching a group of students about therapy for iron toxicity, the instructor determines that the students need additional teaching when they identify that the antidote can be administered by which route? Oral Intramuscular Subcutaneous Intravenous
Oral The antidote for iron toxicity, deferoxamine, can be administered IM, IV, or subcutaneously.
After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia? Pernicious anemia Sickle cell anemia Iron deficiency anemia Folic acid deficiency anemia
Sickle cell anemia Sickle cell anemia is an example of a hemolytic anemia that involves lysing of RBCs because of genetic factors or from exposure to toxins. Iron deficiency anemia is a deficiency anemia. Pernicious anemia and folic acid deficiency anemia are examples of megaloblastic anemia.
The nurse is reviewing the diet of a patient with folic acid deficiency. What would the nurse identify as a poor choice for increasing folic acid in the diet? Liver Eggs Milk Yellow vegetables
Yellow vegetables Folic acid is found in green leafy vegetables, milk, eggs, and liver. Yellow vegetables would be a poor food choice to increase folic acid intake.
A 69-year-old female client has been diagnosed with malignant melanoma. The care team has collaborated with the client and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect?
flu-like symptoms In the majority of clients, flu-like symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.
After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful? "I must take the drug on an empty stomach." "I need to eat three large meals every day." "My stools might turn dark or green." "I need to watch the amount of fiber I eat."
"My stools might turn dark or green." The patient needs to know that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea and GI upset associated with this drug. The patient may take the drug with meals as long as those meals do not include eggs, milk, coffee, and tea. Constipation is possible, so the patient needs to increase the fiber in his diet.
A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect? To increase red blood cells To increase white blood cells To increase electrolytes To decrease leukocytes
To increase white blood cells Filgrastim is used to increase white blood cells and decrease risks of infection in clients who have or are at high risk for severe neutropenia.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Theta cells Beta cells Alfa cells Stem cells
Stem cells All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.
There is a risk of antibody production with the use of epoetin.
True Use of any therapeutic protein brings with it the risk of antibody production. All of the erythropoietic proteins now carry a warning about the potential for this problem.
A patient has pernicious anemia. The nurse understands that this patient cannot absorb which vitamin? Vitamin C Vitamin B12 Vitamin D Vitamin B6
Vitamin B12 Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor, leading to an inability for vitamin B12 to be absorbed. The person with pernicious anemia will experience fatigue and lethargy. The central nervous system also will be affected because of damage to the myelin sheath.
For which client would Procrit NOT be indicated? A client with a hemoglobin of 11, with shortness of breath. A client with a hemoglobin of 12, with shortness of breath. A client with a hemoglobin of 10, who is asymptomatic. A client with a hemoglobin of 8, who is asymptomatic.
A client with a hemoglobin of 12, with shortness of breath. These erythropoiesis-stimulating drugs have been used to raise the hemoglobin and reduce the need for blood transfusions in many patients with anemia. However, studies indicate an increased risk of serious cardiovascular problems and death in patients with chronic renal failure and an increased risk of tumor progression and death in patients with cancer. These problems became evident when the drugs were used to achieve normal hemoglobin levels of 12 to 14 g/dL. These results led the FDA to issue a BLACK BOX WARNING advising prescribers to avoid using the drugs in patients with hemoglobin values of 12 g/dL or above. In addition, when the drugs are used, the lowest dose effective should be prescribed to raise hemoglobin levels just enough to avoid the need for blood transfusion and hemoglobin levels should be monitored regularly until they stabilize.
A male client is taking Procrit. He requests changing his medication from the IM to the PO route. The nurse's best response is: The oral route is not as effective. This medication is destroyed in the stomach and can only be given IM. The drug dose must be increased if being given via the oral route. This medication causes severe diarrhea if given orally.
This medication is destroyed in the stomach and can only be given IM. Exogenous cytokines are given by subcutaneous or intravenous (IV) injection because they are proteins that would be destroyed by digestive enzymes if given orally.
After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue? Altered red blood cell production or deficient functioning of red blood cells A deficiency of vitamin B12 Decreased levels of platelets A defect in white blood cell function
Altered red blood cell production or deficient functioning of red blood cells Anemias are disorders that involve too few or ineffective red blood cells that alter the ability of the blood to carry oxygen. They result from some alteration in erythropoiesis or the process of red blood cell production. White blood cells are associated with the immune response. Lack of vitamin B12 is associated with a specific type of anemia. Platelets are associated with blood clotting.
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer?
Epoetin alfa Epoetin alfa is an erythropoesis-stimulating agent. Ferrous sulfate is used in the treatment of iron-deficiency anemia. Megaloblastic anemia is treated with folic acid. Hydroxyurea is used in the treatment of sickle-cell anemia.
A 69-year-old female client has been diagnosed with malignant melanoma. The care team has collaborated with the client and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect? profound diaphoresis decreased level of consciousness flu-like symptoms cyanosis and pallor
flu-like symptoms In the majority of clients, flu-like symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction? Headache Stomach pain Tarry stools Hypotension
Tarry stools Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.
A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching? "It might take several months before my iron levels get back to normal." "I need to take an antacid with the pill to prevent an upset stomach." "I need to make sure that I eat enough foods containing iron." "I need to avoid taking the drug with coffee or tea."
"I need to take an antacid with the pill to prevent an upset stomach." Iron is not absorbed if taken with antacids, so the client should avoid this combination. Adequate iron intake is necessary to assist in regaining a positive iron balance. It can take 2 to 3 weeks to see an improvement and up to 6 to 10 months to return to a stable iron level once a deficiency exists. Iron absorption also is altered if it is taken with milk, eggs, coffee, or tea. These substances should be avoided.
When administering iron injections, which method would the nurse use?
Z-track intramuscular The Z-track method is used when injecting iron to reduce the risks of subcutaneous staining and irritation.
The nurse is mentoring a first-year nursing student while caring for a client with a disease that affects the hematopoietic system. The student looks confused and says "I've never heard of that system. What is it?" How would the nurse repond?
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets." The nurse would teach the student that the hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets. Fibrin and fibrinogen are part of the clotting cascade, and fibrosis is scar tissue.
A client with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will be administered by the client at home. Which statement indicates that the nurse's initial health education has been successful? "I'll make sure to take my epoetin pill on a strict schedule and make sure I never miss a dose." "I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn." "I'm excited that there's a medication that can help my kidneys work better." "I'm glad that epoetin can help to protect me from getting an infection."
"I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn." The client's statement indicates an understanding of the appropriate route of administration of this medication. Epoetin is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epoetin does not enhance immune function.
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? Increased WBC count Decreased WBC count Decreased RBC count Increased RBC count
Increased RBC count Epoetin is a hormone that stimulates bone marrow production of red blood cells.
A client is receiving darbepoetin alfa. The nurse would inform the client that he will be receiving this drug at which frequency? Every other week Once a week Monthly Two to three times/week
Once a week Darbepoetin alfa is administered once a week. Epoetin alfa is administered three times/week. Methoxy polyethylene glycol-epoetin alfa is administered once every 2 weeks or once a month.
A 22-year-old female client is seen in the primary care provider's office for follow-up. The client was diagnosed six weeks ago with iron deficiency anemia and has been taking the prescribed iron supplement when she notices that her stool has turned black. She tells the nurse that she fears that she is bleeding to death inside her belly. The nurse teaches the client about which expected outcome?
"Don't worry, iron supplements can cause black or dark stools because of the iron composition." Iron supplements can cause black or dark stools because of the iron composition. Bleeding in the stool that causes dark stool from iron administration is not an expected outcome of the drug therapy.
The nurse would contact the prescriber immediately if interferon was prescribed for which client? 34-year-old male with chronic hepatitis B 11-month-old female with HIV acquired from her mother 72-year-old male with AIDS-related Kaposi's sarcoma 48-year-old female with hepatitis C
11-month-old female with HIV acquired from her mother Interferon should not be administered to newborns or infant. A baby is considered an infant until 12 months of age.
The average lifespan of a red blood cell (RBC) is approximately:
120 days The average lifespan of an RBC is 120 days. At that time, the elderly RBC is lysed in the liver, spleen, or bone marrow.
A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time? 36 hours 48 hours 24 hours 12 hours
24 hours Epoetin alfa has a duration of effect of usually 24 hours.
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
A 62-year-old male with cancer Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.
After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue?
Altered red blood cell production or deficient functioning of red blood cells Anemias are disorders that involve too few or ineffective red blood cells that alter the ability of the blood to carry oxygen. They result from some alteration in erythropoiesis or the process of red blood cell production. White blood cells are associated with the immune response. Lack of vitamin B12 is associated with a specific type of anemia. Platelets are associated with blood clotting.
A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?
An iron supplement Patients taking epoetin alfa who require surgery may require iron supplementation.
A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient? Monitor for hypersensitivity reaction. Observe for signs of thrombus formation. Assess prothrombin time (PT) and INR. Assess for signs of bleeding.
Assess prothrombin time (PT) and INR. The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the patient. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in patients who are administered warfarin.
A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route? Oral Subcutaneous Intravenous B and C
B and C These drugs can be give by the SC or IV routes. They are proteins that would be destroyed by digestive enzymes if given orally.
The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit?
Blood pressure The most important assessment is the blood pressure because epoetin can cause hypertension.
The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client? Potassium supplement Renal dialysis Sodium restriction Iron supplement
Iron supplement Iron supplementation is used adjunctively with epoetin to increase RBCs. The nurse would not expect a potassium supplement, sodium restriction or renal dialysis to be ordered.
A client with a diagnosis of renal failure is being treated for anemia with epoetin alfa. Frequent assessment of which laboratory values should be prioritized before and during treatment?
CBC With the use of hematopoietic and immunostimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is not imperative to monitor liver enzymes or renal function.
The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide?
Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Epogen does not slow production of red blood cells or stimulate production of white blood cells.
The nurse notes a decreased red blood cell (RBC) count, decreased hemoglobin and hematocrit, as well as a decreased mean corpuscular volume. This could be attributable to a decrease in secretion of what hormone? Interleukins Erythropoietin Interferon Colony-stimulating factor
Erythropoietin Erythropoietin is a hormone responsible for increasing hemoglobin, red blood cell counts, and mean corpuscular volume. Decreases in any of these could be attributed to a decrease in erythropoietin. The other hormones listed will not have the same effect on the blood studies.
Blood coagulation results from the activation of one of two pathways: one pathway occurs in tissue, and the other occurs in the vascular system. What are the names of these pathways? Clotting and bleeding pathways Outer and inner pathways Exterior and interior pathways Extrinsic and intrinsic pathways
Extrinsic and intrinsic pathways The coagulation process results from the activation of the intrinsic or the extrinsic pathways. The intrinsic pathway is activated by an injury to a blood vessel; the extrinsic pathway is activated by an injury to tissue.
The mature red blood cell contains a nucleus. True False
False In the last phase of RBC production, the cell loses its nucleus and enters circulation. There is no nucleus in a mature red blood cell.
The nurse is teaching a client about folinic acid rescue in chemotherapy. Which of the following information would the nurse include in the teaching plan? Folinic acid rescue in chemotherapy includes Lipitor administration. Folinic acid rescue in chemotherapy includes leucovorin administration. Folinic acid rescue in chemotherapy includes Levophed administration. Folinic acid rescue in chemotherapy includes levothyroxine administration.
Folinic acid rescue in chemotherapy includes leucovorin administration. Folinic acid rescue in chemotherapy includes leucovorin administration. Levophed, Lipitor, and levothyroxine are not part of the acid rescue because the goal is to save cells.
Cyanocobalamin is a vitamin B12 in a nasal formulation. True False
True Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.
The nurse is teaching a client about iron deficiency anemia. The nurse would include in the teaching plan that iron deficiency anemia results from: a lack of iron in the body. a lack of platelets in the body. too much iron in the body. a lack of white cells in the body.
a lack of iron in the body. Iron deficiency anemia results from a lack of iron in the body. Too much iron would cause an excess. Platelets and white cells do not cause iron deficiency anemia.
A client has been receiving regular doses of epoetin alfa for several weeks, and the home care nurse has been monitoring the client's condition closely. When taking the client's vital signs, the nurse should pay particular attention to what assessment datum? temperature blood pressure heart rate respiratory rate
blood pressure The most common adverse effect of epoetin alfa is hypertension. The nurse would critically examine all the client's vital signs, but blood pressure would be of particular concern.
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed?
interferon alfa-2b Interferon alfa-2b is approved for the treatment of genital warts (condylomata) associated with infection by human papillomavirus, non-Hodgkin's lymphoma, and malignant melanoma. Epoetin alfa is a man-made form of a protein that helps the body produce red blood cells. Uses for pegfilgrastim include prevention of infection in neutropenia induced by cancer chemotherapy as well as treatment of bone marrow transplantation for Hodgkin's disease, non-Hodgkin's lymphoma, or acute lymphoblastic leukemia. Darbepoetin alfa is another ESA used in the prevention or treatment of anemia associated with several conditions, including chronic kidney disease and myelosuppressive (depressed bone marrow function) anticancer chemotherapy.
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm?
The patient displays weakness on one side of the body. Epoetin increases the risk of myocardial infarction and stroke. Any symptoms that could indicate these conditions would be cause for alarm. Weakness on one side of the body could indicate a stroke. The nurse should continue with a neurological assessment and alert the health care provider. Bone pain and pain at the injection site are expected side effects and not cause for alarm. Patients who have anemia, the condition which this medication treats, typically report feeling tired and fatigued, and this is not cause for alarm.
Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which fact should underlie the nurse's response to Mr. Lepp? Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely. Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed.
The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. In patients with cancer, epoetin alfa should only be used when anemia is due to concomitant myelosuppressive chemotherapy and should be discontinued when the chemotherapy course is completed. The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are also at risk for serious cardiovascular and thrombovascular events. Consequently, the benefits of treatment must be considered in light of these potentially adverse effects.
A client's current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem?
RBC, hemoglobin, and hematocrit Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration and, hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.
A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa? changing the route of administration temporarily withholding administration requesting a change in the dosage administering an unscheduled dose
temporarily withholding administration Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue.
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed? interferon alfa-2b darbepoetin alfa pegfilgrastim epoetin alfa
interferon alfa-2b Interferon alfa-2b is approved for the treatment of genital warts (condylomata) associated with infection by human papillomavirus, non-Hodgkin's lymphoma, and malignant melanoma. Epoetin alfa is a man-made form of a protein that helps the body produce red blood cells. Uses for pegfilgrastim include prevention of infection in neutropenia induced by cancer chemotherapy as well as treatment of bone marrow transplantation for Hodgkin's disease, non-Hodgkin's lymphoma, or acute lymphoblastic leukemia. Darbepoetin alfa is another ESA used in the prevention or treatment of anemia associated with several conditions, including chronic kidney disease and myelosuppressive (depressed bone marrow function) anticancer chemotherapy.
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's bestresponse? "Increases the release of cells to increase the hemoglobin and hematocrit levels." "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." "Releases erthyropoiesis from the kidneys to increase the number of platelets."
"Increases the release of cells to increase the hemoglobin and hematocrit levels." Epoetin alfa induces erythropoiesis by stimulating erythroid progenitor cells. This causes the release of reticulocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels. The medication does not assist with supplying either WBCs or platelets.
Adverse effects of epoetin and darbepoetin include increased risks of what condition? Hyperlipidemia Cirrhosis of the liver Diabetes mellitus type 2 Myocardial infarction
Myocardial infarction Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.
An adult client has developed renal failure secondary to an overdose of a nephrotoxic drug. Which assessment finding would the nurse recognize as being most suggestive of impaired erythropoiesis? frequent infections and low neutrophil levels increased blood pressure and peripheral edema fatigue and increased heart rate agitation and changes in cognition
fatigue and increased heart rate As RBCs decrease, conditions related to inadequate hematopoiesis develop. Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. A compensatory increase in heart rate and cardiac output initially increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood.
A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa? requesting a change in the dosage changing the route of administration temporarily withholding administration administering an unscheduled dose
temporarily withholding administration Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue.
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? Altered skin integrity due to the disease process Impaired tissue oxygenation related to anemia Alteration in nutrition due to poor intake of iron Alteration in bowel elimination due to side effects of the medication
Impaired tissue oxygenation related to anemia The most appropriate priority nursing diagnosis is impaired tissue oxygenation related to anemia. The other diagnoses are not specific to the reason that epoetin is prescribed or the specific side effects of the medication.
